Keyword: Carcinoma

ABSTRACT: Introduction: Renal cell carcinoma brain metastases are a complication of oncological disease and are associated with an unfavorable prognosis. Stereotactic radiosurgery is one of the main methods of local treatment for intracranial metastases. Data on its outcomes in renal cell carcinoma brain metastases in Kazakhstan are limited.
Objective: To evaluate overall survival, intracranial progression-free survival, and local control after stereotactic radiosurgery.
Materials and Methods: A retrospective cohort study was conducted on patients with renal cell carcinoma brain metastases who underwent stereotactic radiosurgery using the Gamma Knife at the National Center for Neurosurgery between 05.10.2021 and 18.03.2026. The median age was 60 years (44–75), the median Karnofsky Performance Status score was 75 (50–90), and the median prognostic score was 1.5 (0–3.5). Extracranial metastases were present in 25 patients (78.1%), and 21 patients (65.6%) received systemic therapy prior to radiosurgery. Overall survival was assessed in 32 patients; intracranial progression-free survival and local control were assessed in 28 patients with available follow-up magnetic resonance imaging (MRI) studies. For local control assessment, 89 treated lesions were analyzed. Survival rates were calculated using the Kaplan–Meier method. The study was approved by the Bioethics Commission No. 1 of the "National Center for Neurosurgery" JSC (protocol extract No. 7 dated April 13, 2026) and conducted in accordance with the ethical principles of the Declaration of Helsinki.
Results: The median overall survival was 22.1 months. Overall survival rates at 6, 12, and 24 months were 71.4%, 60.8%, and 47.9%, respectively. Among the 28 patients with follow-up MRI studies, the median follow-up period was 4.5 months (1.23–36.13), and the median intracranial progression-free survival was 12.7 months. Intracranial progression was recorded in 11 patients: 9 developed new brain metastases, and 2 had leptomeningeal dissemination. Local control was analyzed in 89 treated metastatic lesions in 28 patients. One case of local progression of a treated lesion was recorded by MRI, detected 9.57 months after treatment. Local control at 6 and 12 months was 100% and 96.8%, respectively.
Conclusions:  Stereotactic radiosurgery using the Gamma Knife provides high local control of renal cell carcinoma brain metastases. Intracranial progression was predominantly due to the appearance of new metastatic lesions and leptomeningeal dissemination, rather than progression of previously treated lesions. The obtained results demonstrate the high efficacy of the Gamma Knife in achieving local control in patients with renal cell carcinoma brain metastases.

ABSTRACT: Background: The introduction of targeted therapy and immune checkpoint inhibitors has significantly improved treatment outcomes in patients with locally advanced and metastatic renal cell carcinoma (mRCC). However, tumor heterogeneity and the development of alternative signaling pathways may contribute to treatment resistance, emphasizing the need for effective combination strategies.
Objective: To evaluate the efficacy of contemporary immunotherapy-based combinations in the first-line treatment of metastatic renal cell carcinoma and identify clinical factors relevant to treatment selection.
Materials and Methods: Published data from randomized phase III studies of first-line systemic therapy for advanced and metastatic renal cell carcinoma were analyzed. Particular attention was given to nivolumab plus ipilimumab and lenvatinib plus pembrolizumab compared with sunitinib. Treatment efficacy was assessed using progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and outcomes according to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk groups.
Results: In the CLEAR trial, lenvatinib plus pembrolizumab significantly prolonged median PFS compared with sunitinib (23.9 vs 9.2 months) and improved overall survival. In patients with intermediate/poor IMDC risk, median PFS was 22.1 months with lenvatinib plus pembrolizumab versus 5.9 months with sunitinib, while ORR was 72.4% versus 28.8%, respectively. Long-term results of the CheckMate 214 trial demonstrated a sustained survival benefit with nivolumab plus ipilimumab compared with sunitinib. The final analysis after a median follow-up of 9.3 years showed an OS hazard ratio of 0.71 in the intention-to-treat population and 0.69 in patients with intermediate/poor IMDC risk. Durable responses were maintained across long-term follow-up.
Conclusions: Immunotherapy-based combinations have substantially improved the treatment of metastatic renal cell carcinoma. Lenvatinib plus pembrolizumab provides significant improvements in PFS and objective response compared with sunitinib, while nivolumab plus ipilimumab demonstrates durable long-term survival benefits. Selection of first-line therapy should consider IMDC risk group, tumor burden, metastatic sites, clinical condition, histological characteristics, and individual patient factors.

ABSTRACT: Hepatocellular adenomas (HCA) are rare benign liver tumors associated with metabolic risk factors and carry a risk of malignant transformation. We present a case of a 50-year-old woman with a liver lesion initially diagnosed as a hepatocellular adenoma that showed progressive growth on follow-up imaging. Contrast-enhanced MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) showed enlargement of the lesion in segments S6–S7. Initial biopsy findings were consistent with hepatocellular adenoma. Because of continued tumor growth, right liver resection was performed. Histopathological examination revealed foci of well-differentiated hepatocellular carcinoma arising within a dysplastic adenoma with areas of necrosis. This case highlights the diagnostic challenges in distinguishing hepatocellular adenoma from early hepatocellular carcinoma, particularly in patients with metabolic risk factors and progressive tumor enlargement. It emphasizes the importance of careful imaging surveillance and timely surgical management.